Provider Demographics
NPI:1871467704
Name:NITKOWSKI, MICHAEL M I (LCSW,LCADC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:NITKOWSKI
Suffix:I
Gender:M
Credentials:LCSW,LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 LAKESIDE DR N
Mailing Address - Street 2:
Mailing Address - City:FORKED RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08731-2203
Mailing Address - Country:US
Mailing Address - Phone:609-879-1966
Mailing Address - Fax:
Practice Address - Street 1:614 LAKESIDE DR N
Practice Address - Street 2:
Practice Address - City:FORKED RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08731-2203
Practice Address - Country:US
Practice Address - Phone:609-879-1966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC064100001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical